Summary:
- When substance use and mental health issues occur together (often called a co-occurring disorder or dual diagnosis), it can be hard to know how to get help. This guide shows you what to expect and how to get started with dual diagnosis treatment.
- Before you begin treatment, you will need to undergo a full assessment. The assessment helps the treatment team determine the type of care that best fits you. Here, we show you how to prepare for your first assessment. We also share a list of questions you can ask when choosing care.
- Coordinated care for dual diagnosis means that one treatment plan addresses both substance use and mental health. The treatment team collaborates, communicates, and works together to keep you safe in treatment and during the transition out of care.
What is dual diagnosis?
In 2024, over 21 million adults in the U.S. (8.1%) were living with both a substance use disorder and a mental health condition. [SAMHSA, 2025] When people struggle with both addiction and mental health concerns at the same time, it’s called dual diagnosis, or co-occurring disorders.
If you’re struggling with substance use and mental health concerns, you may feel upset, embarrassed, or even ashamed. Take a moment to relax and breathe. It’s normal to not know how and where to get help — or what treatment might look like. That’s why we’re providing guidance here.
Note on safety: If there is an immediate risk of overdose, self-harm, suicide, violence, or a medical emergency, call 911 or go to the nearest emergency department. For mental health, suicide, or substance use crisis support in the United States, call or text 988.
The link between substance use and mental health issues
Substance use and mental health concerns are often interconnected. When a person experiences certain mental health symptoms, it can affect how the brain and body react to drugs and alcohol. This can make substances feel even more pleasurable — and make it harder to stop using. [NIMH, 2025]
Similarly, when people experience mental health challenges, they may start using substances more as a way to cope with distress or numb their emotions. Over time, both the substance use and the mental health symptoms can get out of control.
Co-occurring disorders are common and tend to run in families. If you’re dealing with mental health issues and addiction, consider your parents, grandparents, aunts, uncles, and siblings:
- Did others in your family struggle with drinking or drug use?
- Has anyone in your family been diagnosed with a mental health condition or sought treatment for anything like anxiety or depression?
- Did your family ever tell you stories about relatives that have struggled with addiction and mental health concerns?
A unique combination of genes and life experiences can make us vulnerable to certain illnesses. But with a coordinated care approach, you can find healing for both substance and mental health concerns at the same time.
Dual diagnosis treatment: Is it right for you?
Dual diagnosis treatment may be right for you if you no longer have control over how much you are using and you are having distressing mental health symptoms related to:
- Anxiety
- Depression
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Panic disorder
- Personality disorder
- Schizophrenia
If you are ready to get out of a destructive cycle associated with substance use, including financial trouble, relationship problems, legal challenges or difficulties at work, school or home, dual diagnosis treatment may be the answer.
Starting with an assessment
A common question we hear at this stage is, “What will actually happen when I ask for help?” The first step is a full and comprehensive assessment. The treatment team needs to understand who you are and what you’ve been through. They will want to get a clear picture of your background, including a full substance use and mental health history.
The assessment is important for several reasons:
- Substance use and mental health symptoms can overlap. The more the team knows about you, the better they can help you.
- The team will be able to identify what needs immediate attention now and what services will be appropriate over time.
- Some symptoms can worsen if you’ve been recently intoxicated or are going through withdrawal. The assessment will help the team better understand the full picture.
By asking you about past substance use, past mental health symptoms, and any family history of illness, the treatment team can make sure that all issues are addressed in treatment. The goal of the assessment is to understand as much about you as possible, not to assign judgment, blame, or labels. Following the assessment, the team will create a custom plan of care for you.
Try this pre-assessment checklist
Before you begin your dual diagnosis assessment, have the information listed below ready:
- Current and past medical concerns and treatment history
- Current and past mental health concerns and treatment history
- Current and past substance use, including alcohol, sedatives, opioids, stimulants, cannabis, hallucinogens, as well as any addiction treatment history
- Current or past withdrawal symptoms
- Current and past medications
- Current and past medical and mental health providers
- Medical, mental health, and substance use history of close family members
- Any difficulty with daily responsibilities (work, school, family, etc.) [ASAM, 2023]
Be ready to discuss any goals you’d like to achieve. And have your insurance information ready so you can review your benefits. The goal of the initial assessment is to understand what you need and how the treatment team can help you reach your goals.
Choosing a dual diagnosis program
As you reach out to treatment centers, here are some questions that you may want to ask:
- How many assessments are necessary for me to start treatment?
- How long will the assessment(s) take?
- What does treatment look like, and who provides care daily?
- Is treatment individualized, or do all patients complete the same standard program?
- Do you have psychiatric providers on site?
- Who decides if I need to start taking medication or change medications?
- How quickly will I be seen by a provider after admission?
- How often will I have psychiatric care?
- How often will I have therapy?
Christine Schulz, MBA, RN, CEO at Recovery Centers of America in Indianapolis, recommends
“Make sure the center actually treats both mental health and substance use at the same time. Treating one without the other can make it harder to be successful in the long term.”
A full course of treatment provides the best outcomes
When people complete a full course of treatment as recommended by the treatment team, they will have the skills they need to manage cravings, deal with triggers, and move towards their goals.
A full course of treatment may include one or more of the following programs:
- Inpatient/residential or outpatient care (IOP/PHP) (in-person, virtual, and hybrid options)
- Individual therapy incorporating evidence-based therapies like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and the 12 steps
- Group therapy
- Medication-assisted treatment/medically monitored detox
- Sober living/recovery housing
- Aftercare programs including case management and alumni support
- Family coaching, support, and education
With so many flexible and convenient treatment options, there will be a right fit for you. Your treatment team will continually adjust your treatment plan as you make progress.
How to find help
While it’s totally normal to feel worried or overwhelmed when dealing with addiction and mental health concerns, you don’t have to suffer alone. By choosing treatment, you are making one of the best investments in yourself.
The National Institute on Drug Abuse states that substance and mental health treatment is more effective — and health outcomes improve — when people seek treatment for co-occurring disorders at the same time [NIDA, 2024].
If you have questions about dual diagnosis assessment or treatment, contact RCA’s admissions team at 1.800.RECOVERY or contact us.
How do you treat both substance use and mental health concerns at the same time at RCA?
While dual diagnosis care is integrated at Recovery Centers of America (RCA), it is not a one-size-fits-all treatment approach. The team will monitor how changes in sleep, anxiety, mood, cravings, or medication affect your recovery goals each day. The services you receive may be different from other individuals at the same treatment center. Therapy, medication recommendations, case management, and family support all look different from person to person.
Does RCA use medications that can help to reduce withdrawal symptoms?
Yes, RCA provides medically supervised detox along with medication-assisted treatment (MAT). MAT uses FDA-approved medications (methadone, suboxone, and others) along with other therapies to treat opioid and alcohol use disorders. We are also equipped to treat post-acute withdrawal syndrome (PAWS), should it arise. PAWS is a cluster of physical, emotional, and cognitive symptoms that persist beyond the initial withdrawal from alcohol or drugs.
I’m a working parent. Is it possible to get help from RCA while maintaining my job and family responsibilities?
New technologies allow us to offer multiple treatment options with more flexibility than ever before. This allows you to maintain responsibilities at home, work, school, or elsewhere in your life while focusing on your recovery.
- RCA’s WorkFlex program (includes up to three hours of daily work sessions five to seven days per week for those in our inpatient/residential programs)
- Virtual (online) intensive outpatient program (IOP) offers dual diagnosis treatment from the comfort of home
- RCA offers intensive outpatient programs (IOP) with both day and evening hours to fit around you work or school schedule
How can I compare different dual diagnosis treatment options?
We asked Carter Serrett, MA, MBA, LPA, PsyD candidate and CEO at Recovery Centers of America in Raritan Bay, this question. Carter replied, “I think it’s important to ask about the therapies/modalities the program uses and how confident they are. Take dialectical behavioral therapy (DBT) as an example. DBT has strong evidence for mental health and substance use. But does the center only claim to use it, or have they fully embraced it within their clinical language?” Carter also recommends that you ask about medication-assisted treatment (MAT), “Does the program offer MAT for substance use? A program that does not offer MAT may not fully understand what it’s like to work with people with substance and mental health history.”
Are family members included in treatment?
We asked Christine Schulz, MBA, RN, CEO at Recovery Centers of America in Indianapolis, about family involvement in treatment. She replied, “Addiction doesn’t just impact the person coming into treatment; it impacts the whole family. We work hard to keep families involved through communication, education, and being part of the treatment process, when appropriate. We help families understand addiction and recovery, as well as how to rebuild trust, support their loved one, and take care of themselves.”
Carter Serrett, MA, MBA, LPA, PsyD candidate and CEO at Recovery Centers of America in Raritan Bay, shared, “Families often need support and help navigating communication, empathy, and boundaries. At RCA Raritan Bay, we host a weekly moms’ group that stays open to any mother whose child has been in our care. Support lasts well beyond the last treatment session provided.”
Will you share the details of my assessment with my family members?
Your private health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). There are instances where we may communicate details of your care with your family members, friends, or others — but only if you have already involved them in your health care and you do not object if we ask you for permission. Typically, we would only share information that is directly related to your care.
How soon can I be admitted to treatment?
You may contact us to be admitted 24 hours a day, 7 days a week, 365 days a year. We are open on holidays, nights, and weekends
This article is for educational purposes and is not a substitute for medical advice, diagnosis, or treatment. If you need help, please see a licensed clinician.
Sources
- Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
- National Institute of Mental Health: Finding Help for Co-Occurring Substance Use and Mental Disorders. Published March 2025. Accessed September 2026.
- National Institute on Drug Abuse: Co-Occurring Disorders and Health Conditions. Published September 2024. Accessed September 2026.
- American Society of Addiction Medicine. (2023). The ASAM Criteria®, Fourth Edition Level of Care Assessment Guide: Adults (Version 4.1.0.0). Available via the ASAM Assessment Guides Page or direct ASAM Level of Care Assessment Guide PDF. [1, 2]
